Optic neuritis | Non-arteritic ischemic optic neuropathy | Arteritic ischemic optic neuropathy | Leber hereditary optic neuropathy | Neuroretinitis | |
Age | 20 to 50 years | >50 years | >70 years | 25 to 40 years | Children |
Sex | 2:1 female | Equal | 3.5:1 female | 80 to 90 percent male | Equal |
Pain | Present in >90 percent | Present in <10 percent | Headache, scalp tenderness, jaw claudication | Not present | Variable |
Onset | Hours to days | Sudden | Sudden | Weeks to months | Hours to days |
Unilateral or bilateral | Usually unilateral | Usually unilateral; low chance may recur in other eye years later | May occur in both eyes in rapid sequence | Bilateral, but presentation often unilateral | Often bilateral |
Funduscopic examination | Papillitis present in one-third | Papillitis present in most | Pale swelling of disc; fundus may also be normal (posterior ischemic optic neuropathy; indicates giant cell arteritis) | Disc hyperemia but no swelling; peripapillary telangiectasia | Papillitis, macular edema, exudates |
Visual field defect | Central scotoma | Altitudinal (usually inferior) defect | Altitudinal or generalized constriction | Central or cecocentral defect | Variable |
Magnetic resonance imaging: optic nerve | Inflammation of optic nerve in most (one-third to one-half will have other demyelinating lesions) | Often normal | May show enhancement | Normal | Variably abnormal |
Prognosis | Begins within 2 to 4 weeks, most achieve 20/40 or better | Over several months, only 40 percent improve by 3 or more lines | Poor once vision loss has occurred; may cause rapid blindness untreated | One-third achieve some improvement | Most recover fully |
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